Consultant Urologist Mr Paul Miller sacked by Surrey NHS Trust: rogue doctor or another systemic failing in care?

East Surrey Hospital released a press release on 15 October 2014 announcing that the consultant urologist, Mr Paul Miller, had been sacked from his post at the Earlswood Hospital.

This announcement came after an investigation found that 27 people had come to serious significant harm because of the treatment they had received under his care; in fact they speculate that up to 1,200 people under his care may have been treated wrongly. Although they said that the alarm had been raised in November last year, when Dr Miller's fellow consultants and specialist nurses had expressed concerns about his practice, the care examined dated from 2006, suggesting that the care he provided may have been of serious concern for at least 7 years before anyone raised the alarm within the Trust. There has been no comment by the Trust as to why it took 7 years to identify failings in his practice (if there were failings); so far it looks like the Trust seeks to distance itself from the care provided by this consultant as far as possible. However he must have been acting as part of the urology and oncology team at the Trust, ie he was not practicing in isolation of his colleague, and the same team that reported concerns about him in December 2013 must surely have been able to identify failings in his care earlier than November 2013. This approach to managing the fallout from mass failings in care by one doctor is similar to the handling of the Rod Irvine matter back in July 2013, where the South London Healthcare NHS Trust announced that they were reviewing the care of around 2000 patients who had had surgery at their hospitals over the past 10 years under Rod Irvine. They even set up an information hotline for women who may have been treated by him. He is currently being investigated by the General Medical Council, as is Paul Miller, and the hearing is likely to take place in May next year. Unlike the Paul Miller case, the Trust did not dismiss Rod Irvine, but rather they excluded him and banned him from clinical work at the Trust.

What is common in both cases, and in many other similar matters like this where an individual doctor is identified as having provided repeatedly poor care, is the distancing of the Trust from that clinician's judgment and actions. Yet are we really supposed to imagine that the Trust, and other institutions managing these clinicians, bear no responsibility for the monitoring and management of the services they provided, and that there was no earlier opportunity to identify the failings in their care or instances of medical negligence?

These mass failings should also be considered in the context of the most recent Care Quality Commission "State of Care" Report published in October of this year, where the CQC found 4 out of 5 hospitals to be unsafe. They identified, for instance, shortages of consultants and nurses as a contributing factor in poor safety standard. They highlighted problems with staffing as being most acute in A&E, maternity and mental health teams across the UK. .

So next time an individual clinician is slated for appalling practice let us look behind their practice at what led to them being able to practice sub‑standard medicine unchecked. Let us look at what improvements can be put in place to prevent such poor care recurring. Let us remember that teams are built around consultants who are god‑like in their power to impact on the quality of their team be they nurses or clinicians. They teach those under them, creating junior doctors in their own image, and if their practice is flawed, those flaws are reproduced. Until the NHS and the private medical sector open themselves up to greater scrutiny, and are much more transparent in dealing with mistakes and offering redress to patients, we will continue to have these "rogue" clinicians practising poor medicine which affects the lives of thousands of patients. I would argue that the individual clinicians are not the main problem, the fundamental problem lies within a systemic failing in the clinical system to recognise and deal swiftly with poor provision of care. We must therefore continue to strive to use clinical negligence litigation to promote improved patient safety and the high standard of medicine that the majority of clinicians, and healthcare providers aspire to provide.